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Home My WebLink About19813-z FO~.M NO. II TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PEPJv41T (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Ne_ 19813 Z Permission is hereby gmnte~J to: /~ , ,,,-% . ....~.~..~..~.~ ...................................................~ ....~...~.~...~.:~.~....~..!.~.~:....~. ,o ................................ rem, es I at d at .~ ~.. ~ ~ ~ .... ~ County Tax /V~ap No. 1000 Sectio~.n_<...~..?...~ ........ Block .....(~......~... ......... Lot No....~...:..1 .............. pursuant to application dated ...~~. ......... ...:~....~T.. ................ , 19..~..I.., and approved by the Building Inspector. Fee $..~....~,......~.... ..... Building Inspector Rem 6/30/80 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 :~xamincd , .(~...4%~..., 197.l. kpproved . .'~..~'--.., 199l. Permit No. ] .~ .~. !..~..'~. Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS BOARD OF HEALTtt ......... 3 SETS OF PLANS .......... SURVg~ ................... CIIECK~' .................... SEPTIC.,FORH .............. CALL ................... HAIL TO: Date ~..?.alL ! ~., 19g/. a. Tiffs application must be completely filled in by Wpewriter or in ink and submitted to the Building Inspector, with 3 :ts'of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets r ao'eas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- ~tion. c. The work covered by tiffs application may not be c'bmmenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permit tall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy tall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the uilding' Zone Ordinance of the 'Town of Southotd, Suffolk County, New York, and other applicable Laws, OrdLn~nces or egulatio,ns, for the construction.of buildings, additions or alterations, or for removal or demolition, as herein described. he applicant agrees to con]ply with ail applicable laws, ordinances, building code, housing code, and regulations, and to lmit authorized inspectors on premises and in building for necessary inspections. _ ... i<' ......... (Signature of applicant, or name, if a corporation) .?, P., N...¢ (Mailing address of applicant) ~ ' ate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. . .~.~..~..c4 ........................................................... ... ....................... amc of owner ofpremises ~!o..~.~J~..~o.~..~..~>q.M?.fl.~/ ................................................. (as on the t .a:t' roll or latest deed) · applicant is a corporation, signature of duly authorized officer. " (Name and title of corporate officer) B llder s L, cense No. ..~9.~. P~umber's License No ......................... E ectnc an s Lzcense No .............. . ....- ..... Other Trade's License No · Location of land on which proposed work will be done ....... f...?~9.~, f~..9 .......................... House Nulnber Street Hamlet County TaxMapNo. 1000 Section .[../~..~ ............. Block..~.,~... ............ Lot...~...~..~.l ........ Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ......................................... ~ ,,~,.~,~ ....... ~ . · . .,,. · ,~? ., .~ ........ b. Intended use and occupancy .......... 3. Nature of work (check which applicable): N Repair .............. Remdval ..... 4. Estimated Cost 5. If dwelling, number of dwelling Units .. . · If garage, number of cars ..... ! ........ 6. If business, commercial or mixed, occupanc3 7. Dimensions of existing structured, if any: Fx Height ............... Number of Stor/ Dimensions of same structure wi(h alteratio: Depth .................... i. Height . 8. Dimensions of entire new constrUction: Fro Height ............... Number of Stori 9. Size of lot: Front ............ ! ........ I0. Date of Purchase .......... l l. Zone or use district in which 12. Does proposed construction violalte any zoni 13. Will lot be regraded .......... I ........ 14. Name of Owner of premises .... i ........ Name of Architect ........... i ........ Name of Contractor .......... i ......... 15. Is this property within 300 feet o *If yes, Southold Tdwn Trust Locate clearly and distinctly all buildings, ~roperty Hnes. Give street and block n~mber or ifi~terior or coruer lot. *w Building ... ........ Dem specify nature ,nt ......... m or additions: it ...... · Rear ........ Nam, aated ........ Addition .......... Alteration ....... .............. Other x,V~ · ?...~. ,. o ~ ..... (Description) (to be mid on filing this application) nber of dwelling units on each floor ........ nd extent of each type of use Rear ~ D pth t ........ Rear ..... ....... Number or,Stones .............. Rear ............... Depth ............ ........ Depth ...... ,f Former Owner ......... ag law, ordinanc or regulation: ..................... ......... Will ~xcess fill be removed from >remises: Yes No ....... t ....... Phone No ............. ....... Addre ............... Phone No ............ ...... Addre! .... Phon~.9 ..... ~ a 'tidal wet~ ~nd? *Yes ...... No ........ ''~ ~-es Permit be uired. PLOT DIAG~ heth~r existing and. indicate dbnensmns from scriptio~i acc g to deed, and show street names and indicate whether APPROVED AS NOTED DATE: q/~4q, B.R # ~ 7fi~-1802 9 AM TO 4 PM FOR THE INSPECTIONS: 1. JIRED FOR POURED CONCRETE ROUGH - FRAMING & PLUMBING . INSU~TION CONSTRUCTION MUST 8E COMPLETE FOR C,O ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N.Y. STATE CONSTRUCTION & ENERGY CODES. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS TATE OF NE4V'~O R~ ~ / 1 ~ (Name of individual signing ?ntract) )Dye named· e is the ....................... l ....... ! (Contn · said owner or owners, and is duly authorized tc 'plication; that all statemants containe0 in this an ork will be performed in the manner se! forth in t~ yom to before me this .... being duly sworn, deposes and says that he is the applicant to orporate officer, etc.) ..................... 3erform or have performed the said work and to make and file this 31ication are true to the best of his knowledge and belief; and that the ~ application filed therewith. ~' ',: ........ xG,, .-.-Co. ,~. Coun~ ~t. AIRE L. (~LEW., Notify Publlo. 8tare of N~w 1~1~ No. 4879606 ' OuMlfl~d in Su~otk Counfly (Signature of applicant)